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AIMS: Loss of expression of tumour suppressor PAX2 and MMR deficiency (dMMR) has been frequently seen in endometrial endometrioid adenocarcinoma (EEC). However, the relationship between PAX2 expression and MMR status is unknown. METHODS AND RESULTS: We studied the PAX2 expression and examined its association with MMR status at the protein and genetic levels in 180 cases of EEC. Overall, total loss of PAX2 expression was found in about 70%, while retained PAX2 expression was seen in 30% of EEC. Among 125 cases with loss of PAX2, 68.8% were found in EECs with pMMR, while 31.2% were seen in those with dMMR. Among 55 cases of EECs with retained PAX2 expression, 92.7% were EECs with dMMR and 7.3% were those with pMMR (P < 0.001). While dMMR cases with MLH1 hypermethylation show almost equal retained or loss of PAX2 expression (52% versus 48%), dMMR with genetic alterations had significantly more retained PAX2 expression than loss of PAX2 (92.3% versus 7.7%), regardless of somatic or germline mutations. Loss of PAX2 was observed in 97.3% of dMMR with MLH1 hypermethylation compared to 2.7% of dMMR with genetic alterations (P < 0.001). Aggressive features such as higher tumour grades (FIGO 2-3) and advanced clinical stage (T2-T4) were significantly more frequently seen in dMMR with retained PAX2 expression, compared those to pMMR with loss of PAX2 expression. CONCLUSION: Our study demonstrates a close correlation between retained PAX2 expression and dMMR in EEC. The molecular mechanism and clinical significance linking these two pathways in EEC remains to be unravelled.

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BACKGROUND: Music therapy and culture are interconnected. It is unclear whether the therapeutic effects of music can be exerted in diverse cultural contexts. Both Western-based and Chinese Five elements music therapy (FEMT) have shown effectiveness in improving the perception of stress, anxiety and depression in their respective cultures. FEMT is a commonly used traditional Chinese Medicine approach; however, it has not been investigated with non-Chinese participants. PURPOSE: To investigate the impact of FEMT and of Western-based music therapy on stress and related outcomes and explore cross-cultural comparisons in participants from Chinese and Canadian contexts. METHODS: This pre-post randomized controlled study was conducted with 35 participants, 23 from Canada and 12 from China. Participants from the two cultural groups were randomly divided into two groups: a FEMT group (n = 20), a western art music therapy (WAMT) group (n = 15). The main outcome was self-rated stress, evaluated by a 10-point numeric rating question. Secondary outcomes included anxiety/depression (Hospital Anxiety and Depression Scale (HADS), pulse rate and qualitative comments. Cross-sectional, pre-post and longitudinal comparisons were pursued. RESULTS: We observed comparable effects of FEMT and WAMT in both the Chinese and Canadian samples. There was a statistically significant decrease in self-rated stress over time, especially after the conclusion of the four-week music therapy intervention (p = 0.001), regardless of type of music therapy, and in both cultural contexts. We observed a statistically significant decrease in anxiety and depression scores in the FEMT group only (p<0.001), but no effect on pulse rate. CONCLUSION: This is the first study to report evidence of feasibility, acceptability and effectiveness of FEMT in non-Chinese participants. Further investigation of the observed differences is warranted.

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OBJECTIVE@#To examine the impact of COVID-19 pandemic on the epidemic status of imported malaria and national malaria control program in China, so as to provide insights into post-elimination malaria surveillance.@*METHODS@#All data pertaining to imported malaria cases were collected from Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region during the period from January 1, 2018 through December 31, 2021. The number of malaria cases, species of malaria parasites, country where malaria parasite were infected, diagnosis and treatment after returning to China, and response were compared before (from January 1, 2018 to January 22, 2020) and after the COVID-19 pandemic (from January 23, 2020 to December 31, 2021).@*RESULTS@#A total of 2 054 imported malaria cases were reported in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region during the period from January 1, 2018 to December 31, 2021, and there were 1 722 cases and 332 cases reported before and after the COVID-19 pandemic, respectively. All cases were reported within one day after definitive diagnosis. The annual mean number of reported malaria cases reduced by 79.30% in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region after the COVID-19 pandemic (171 cases) than before the pandemic (826 cases), and the number of monthly reported malaria cases significantly reduced in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region since February 2020. There was a significant difference in the constituent ratio of species of malaria parasites among the imported malaria cases in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region before and after the COVID-19 pandemic (χ2 = 146.70, P < 0.05), and P. falciparum malaria was predominant before the COVID-19 pandemic (72.30%), while P. ovale malaria (44.28%) was predominant after the COVID-19 pandemic, followed by P. falciparum malaria (37.65%). There was a significant difference in the constituent ratio of country where malaria parasites were infected among imported malaria cases in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region before and after the COVID-19 pandemic (χ2 = 13.83, P < 0.05), and the proportion of malaria cases that acquired Plasmodium infections in western Africa reduced after the COVID-19 pandemic that before the pandemic (44.13% vs. 37.95%; χ2 = 4.34, P < 0.05), while the proportion of malaria cases that acquired Plasmodium infections in eastern Africa increased after the COVID-19 pandemic that before the pandemic (9.58% vs. 15.36%; χ2 = 9.88, P = 0.02). The proportion of completing case investigation within 3 days was significantly lower after the COVID-19 pandemic than before the pandemic (96.69% vs. 98.32%; χ2= 3.87, P < 0.05), while the proportion of finishing foci investigation and response within 7 days was significantly higher after the COVID-19 pandemic than before the pandemic (100.00% vs. 98.43%; χ2 = 3.95, P < 0.05).@*CONCLUSIONS@#The number of imported malaria cases remarkably reduced in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region of China during the COVID-19 pandemic, with a decreased proportion of completing case investigations within 3 days. The sensitivity of the malaria surveillance-response system requires to be improved to prevent the risk of secondary transmission of malaria due to the sharp increase in the number of imported malaria cases following the change of the COVID-19 containment policy.

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Objetivo Evaluar la tendencia de la incidencia y la supervivencia estratificada por edad, raza, género y nivel socioeconómico (NSE), así como la variación en el tiempo de las diferencias entre los grupos de pacientes con carcinoma urotelial del tracto superior (CUTUS) en estadio III-IV. Métodos Se extrajeron los datos de 7.505 pacientes diagnosticados de CUTUS en estadio III-IV de la base de datos Surveillance, Epidemiology and end results (SEER) entre 2004 y 2015. Las tasas de supervivencia global (SG) y supervivencia cáncer específica (SCE) se evaluaron mediante la curva de Kaplan-Meier y la prueba de rango logarítmico y con análisis de regresión de Cox multivariable. Resultados De los 7.505 pacientes, 3.584 se clasificaron como jóvenes, 2.464 como de mediana edad y 1.461 como ancianos. El año del diagnóstico se clasificó en tres periodos: 2004-2007, 2008-2011 y 2012-2015. La tasa de incidencia de CUTUS fue de 0,69, 0,74 y 0,77 por 100.000 en el primer, segundo y tercer periodo, respectivamente. Las disparidades en la tasa de supervivencia a largo plazo entre hombres y mujeres, y entre pacientes de diferentes razas, se redujeron con el tiempo. No hubo diferencias entre razas en términos de pronóstico (p = 0,078 para la SG y p = 0,167 para la SCE). La diferencia de las tasas de supervivencia entre el grupo de menor NSE y grupo de mayor NSE se redujo a lo largo de los tres periodos de tiempo. Conclusiones Las disparidades en las tasas de supervivencia según sexo, raza y NSE se redujeron con el tiempo, excepto en los pacientes de 74 a 82 años. La edad más avanzada, la raza negra y el NSE bajo, se asocian a peores resultados de supervivencia. En general, la tasa de supervivencia a largo plazo mejoró de forma continuada a lo largo de los tres periodos (AU)

Objective To assess the trend of incidence and survival stratified by age, race, gender and SES and the differences in time between groups in stage III–IV upper tract urothelial carcinoma (UTUC) patients. Methods 7,505 stage III–IV UTUC patients between 2004 and 2015 were extracted from the Surveillance, Epidemiology and End Results (SEER) database. The overall survival (OS) and the cancer-specific survival (CSS) rates were assessed using the Kaplan-Meier curve and log-rank test as well as multivariate Cox regression analysis. Results Among the 7,505 patients, 3,584 were classified as young, 2,464 were classified as middle-aged, and 1,461 were classified as elderly. The years of diagnosis were divided into three periods including 2004-2007, 2008-2011 and 2012-2015. The incidence rates for UTUC were 0.69, 0.74, and 0.77 per 100,000 in the first, second, and third period, respectively. Disparities in the long-term survival rate between male and female patients and among patients of different races narrowed over time. There was no difference in prognosis between races (p = 0.078 for OS and p = 0.167 for CSS). The difference in survival rate between the poor and rich groups narrowed along with the three time periods. Conclusions Survival rate disparities according to sex, race, and socioeconomic status narrowed in time, except in patients aged 74-82 years. Increased age, black race, and poverty are associated with worse survival outcomes. In general, the long-term survival rate improved continuously across the three periods (AU)

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Objetivos Realizamos este metaanálisis para evaluar la precisión diagnóstica de los microARN (miARN) circulantes para el diagnóstico precoz del cáncer de próstata (CaP).Métodos Se realizó una búsqueda bibliográfica sistemática (actualizada al 18 de febrero de 2021) en PubMed, EMBASE, Web of Science, Cochrane Library, base de datos Wanfang y China National Knowledge Infrastructure (CNKI) para identificar los estudios elegibles. La sensibilidad (SEN), la especificidad (SPE), la razón de verosimilitud positiva (PLR), la razón de verosimilitud negativa (NLR), la razón de probabilidades de diagnóstico (DOR) y el área bajo la curva (AUC) de la curva característica de funcionamiento del receptor (SROC) se agruparon tanto para el análisis general como para el de subgrupos. La metarregresión y el análisis de subgrupos se realizaron para explorar la heterogeneidad y se utilizó el gráfico en embudo de Deek para evaluar el sesgo de publicación.Resultados Ciento diecinueve estudios de 33 artículos pertenecientes a 8.703 pacientes con CaP y 4.914 controles se incluyeron en nuestro metaanálisis. La SEN, la SPE, la PLR, la NLR, la odds ratio diagnóstica y el AUC para el análisis general fueron 0,79, 0,81, 4,1, 0,26, 16 y 0,87, respectivamente. La SEN, la SPE, la PLR, la NLR, la odds ratio diagnóstica y el AUC agrupadas de miR-21 en el diagnóstico del CaP fueron 0,86, 0,90, 8,3, 0,16, 52 y 0,94, respectivamente. El análisis de subgrupos sugirió que el miARN sérico regulado al alza con un tamaño de muestra grande podría llevar a cabo una mejor precisión diagnóstica de los pacientes con CaP. Además, no se encontró sesgo de publicación.Conclusiones El miARN circulante, especialmente el miR-21, puede utilizarse como un biomarcador no invasivo prometedor en el diagnóstico precoz del CaP (AU)

Objectives This meta-analysis has been conducted to evaluate the diagnostic accuracy of circulating microRNAs for the early diagnosis of prostate cancer (PCA).Methods A systematic literature search was performed (updated to February 18, 2021) in PubMed, EMBASE, Web of Science, Cochrane Library, Wanfang database and China National Knowledge Infrastructure (CNKI) to identify eligible studies. The pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under curve (AUC) of the summary receiver-operating characteristic (SROC) curve were calculated for both overall and subgroup analysis. The meta-regression and subgroup analysis were performed to explore heterogeneity and Deeks’ funnel plot was used to assess publication bias.Results One hundred nineteen studies from 33 articles owned 8703 PCA patients and 4914 controls were included in our meta-analysis. The overall sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under the curve were 0.79, 0.81, 4.1, 0.26, 16 and 0.87, respectively. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve of miR-21 in diagnosis of PCA were 0.86, 0.90, 8.3, 0.16, 52 and 0.94, respectively. Subgroup analysis suggested that the upregulated miRNA of serum type with large sample size could carry out a better diagnostic accuracy of PCA patients. Moreover, publication bias was not found.Conclusions Circulating microRNA, especially miR-21, can be used as a promising noninvasive biomarker in the early diagnosis of PCA (AU)

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BackgroundHow international migrants access and use primary care in England is poorly understood. We aimed to compare primary care consultation rates between international migrants and non-migrants in England before and during the COVID-19 pandemic (2015- 2020). MethodsUsing linked data from the Clinical Practice Research Datalink (CPRD) GOLD and the Office for National Statistics, we identified migrants using country-of-birth, visa-status or other codes indicating international migration. We ran a controlled interrupted time series (ITS) using negative binomial regression to compare rates before and during the pandemic. FindingsIn 262,644 individuals, pre-pandemic consultation rates per person-year were 4.35 (4.34-4.36) for migrants and 4.6 (4.59-4.6) for non-migrants (RR:0.94 [0.92-0.96]). Between 29 March and 26 December 2020, rates reduced to 3.54 (3.52-3.57) for migrants and 4.2 (4.17-4.23) for non-migrants (RR:0.84 [0.8-0.88]). Overall, this represents an 11% widening of the pre-pandemic difference in consultation rates between migrants and non-migrants during the first year of the pandemic (RR:0.89, 95%CI:0.84-0.94). This widening was greater for children, individuals whose first language was not English, and individuals of White British, White non-British and Black/African/Caribbean/Black British ethnicities. InterpretationMigrants were less likely to use primary care before the pandemic and the first year of the pandemic exacerbated this difference. As GP practices retain remote and hybrid models of service delivery, they must improve services and ensure they are accessible and responsive to migrants healthcare needs. FundingThis study was funded by the Medical Research Council (MR/V028375/1) and Wellcome Clinical Research Career Development Fellowship (206602).

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BackgroundThere is limited research focusing on publicly available statistics on the Coronavirus disease 2019 (COVID-19) pandemic as predictors of mental health across countries. Managers are at risk of suffering from mental disorders during the pandemic because they face particular hardship. ObjectiveWe aim to predict mental disorder (anxiety and depression) symptoms of managers across countries using country-level COVID-19 statistics. MethodsA two-wave online survey of 406 managers from 26 countries was finished in May and July 2020. We used logistic panel regression models for our main analyses and performed robustness checks using ordinary least squares regressions. In the sample of 406 managers from 26 countries, 26.5% of managers reached the cut-off levels for anxiety (General Anxiety Disorder-7; GAD-7) and 43.5% did so for depression (Patient Health Questionnaire-9; PHQ-9) symptoms. FindingsWe found that cumulative COVID-19 statistics (e.g., cumulative cases, cumulative cases per million, cumulative deaths, and cumulative deaths per million) predicted managers anxiety and depression symptoms positively, whereas daily COVID-19 statistics (daily new cases, smoothed daily new cases, daily new deaths, smoothed daily new deaths, daily new cases per million, and smoothed daily new cases per million) predicted anxiety and depression symptoms negatively. In addition, the reproduction rate was a positive predictor, while stringency of governmental lockdown measures was a negative predictor. Individually, we found that the cumulative count of deaths is the best single predictor of both anxiety and depression symptoms. ConclusionsCumulative COVID-19 statistics predicted managers anxiety and depression symptoms positively, while non-cumulative daily COVID-19 statistics predicted anxiety and depression symptoms negatively. Cumulative count of deaths is the best single predictor of both anxiety and depression symptoms. Reproduction rate was a positive predictor, while stringency of governmental lockdown measures was a negative predictor.

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Wearing a face mask has been a key approach to contain or slow down the spread of COVID-19 in the ongoing pandemic. However, there is huge heterogeneity among individuals in their willingness to wear face masks during an epidemic. This research aims to investigate the individual heterogeneity to wear face masks and its associated predictors during the COVID-19 pandemic when mask-wearing was not mandatory but individuals choices. Based on a survey of 708 Malaysian adults and a multivariate least-squares fitting analysis, the results reveal a significant variance among individuals in wearing masks, as 34% of the individual adults did not always wear masks in public places. Female, individuals who wash their hands more frequently, and those who reported more availability of personal protective equipment were more likely to practice mask-wearing. The identification of less compliant groups of mask-wearing has critical implications by enabling more specific health communication campaigns.

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The COVID-19 pandemic in Brazil is extremely severe, and Brazil has the third-highest number of cases in the world. The goal of the study is to identify the prevalence rates and several predictors of depression and anxiety in Brazil during the initial outbreak of COVID-19. We surveyed 482 adults in 23 Brazilian states online on 9-22 May 2020, and found 70.3% of the adults (N=339) had depressive symptoms and 67.2% (N=320) had anxiety symptoms. The results of multi-class logistic regression models revealed that females, younger adults and those with fewer children had a higher likelihood of depression and anxiety symptoms; adults who worked as employees were more likely to have anxiety symptoms than those who were self-employed or unemployed; adults who spent more time browsing COVID-19 information online were more likely to have depression and anxiety symptoms. Our results provide preliminary evidence and early warning for psychiatrists and healthcare organizations to better identify and focus on the more vulnerable sub-populations in Brazil during the ongoing COVID-19 pandemic.

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ObjectiveThere is a lack of evidence related to the prevalence of mental disorder symptoms as well as their heterogeneities during the COVID-19 pandemic in Latin America, a continent across the equators. The current study aims to provide meta-analytical evidence on mental disorder symptoms during COVID-19 among frontline healthcare workers, general healthcare workers, the general population, and university students in Latin America. MethodsBibliographical databases, such as PubMed, Embase, Web of Sciences, PsycINFO, and medRxiv, were systematically searched to identify pertinent studies up to Februry 6, 2021. Two coders performed the screening using predefined eligibility criteria. Studies were assigned quality scores using the Mixed Methods Appraisal Tool. The double data extraction method was used to minimize data entry errors. ResultsA total of 33 studies with 101,772 participants in Latin America were identified. The pooled prevalence of anxiety, depression, distress, and insomnia was 32%, 27%, 32%, and 35%, respectively. There was a higher prevalence of mental health symptoms in South America compared to Central America (33% vs. 27%, p <0.001). The pooled prevalence of mental health symptoms in the general population, general healthcare workers, frontline healthcare workers, and students in Latin America was 33%, 31%, 37%, and 36%, respectively. ConclusionThe high yet heterogenous level of prevalence of mental disorder symptoms emphasizes the need for appropriate identification of psychological interventions in Latin America.

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AimsThe Covid-19 pandemic has had a substantial impact on the mental health of the general public and high-risk groups worldwide. Due to its proximity and close links to China, Southeast Asia was one of the first regions to be affected by the outbreak. The aim of this systematic review was to evaluate the prevalence of anxiety, depression and insomnia in the general adult population and healthcare workers (HCWs) in Southeast Asia during the course of the first year of the pandemic. MethodsSeveral literature databases were systemically searched for articles published up to February 2021 and two reviewers independently evaluated all relevant studies using pre-determined criteria. The prevalence rates of mental health symptoms were calculated using a random-effect meta-analysis model. ResultsIn total, 32 samples from 25 studies with 20,352 participants were included. Anxiety was assessed in all 25 studies and depression in 15 studies with pooled prevalence rates of 22% and 16% respectively. Only two studies assessed insomnia, which was estimated at 19%. The prevalence of anxiety and depression was similar amongst frontline HCWs (18%), general HCWs (17%), and students (20%) whilst being noticeably higher in the general population (27%). ConclusionsThis is the first systematic review to investigate the mental health impact of the Covid-19 pandemic in Southeast Asia. A considerable proportion of the general population and HCWs reported mild to moderate symptoms of anxiety and depression; the pooled prevalence rater, however, remain significantly lower than those reported in other areas such as China and Europe.

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ObjectiveIn this paper, we aim to provide a systematic review and meta-analysis on the prevalence rates of mental health symptoms of anxiety, depression, and insomnia among the major populations during the COVID-19 pandemic in Africa. DesignA systematic review and meta-analysis. Data sourcesWe search and include articles using PubMed, Embase, Web of Science, PsycINFO, and medRxiv databases between Feb 202 and Feb 6th, 2021. Eligibility criteria and data analysisThe meta-analysis targets the prevalence rates of mental health symptoms of major populations including frontline/general healthcare workers (HCWs), the general adult population, and medical students during the COVID-19 pandemic in Africa. To estimate the prevalence rates of anxiety, depression, and insomnia, we pooled data using random-effects meta-analyses. ResultsIn this meta-analysis, we identify and include 28 studies and 32 independent samples from 12 countries with a total of 15,072 participants in Africa. Ethiopia (7) and Egypt (6) had the largest number of studies. While many countries including, but not limited to, Algeria, Kenya, and Ghana had a high number of COVID-19 cases, as many as three quarters of African countries have no studies. The pooled prevalence of anxiety in 27 studies was 37% (95%CI: 31-43%, I2 = 99.0%) and that of depression in 24 studies was 45% (95%CI: 36-51%, I2 = 99.5%) and that of insomnia in 9 studies was 28% (95%CI: 20-41%, I2 = 99.2%). The pooled prevalence rates of anxiety, depression, and insomnia in North Africa (44%, 55%, and 31%, respectively) are higher than the rates in Sub-Saharan Africa (31%, 30%, and 24%, respectively). Our analysis indicated high heterogeneity and varying prevalence rates of mental health symptoms during the COVID-19 pandemic in Africa. DiscussionWe discuss our findings that a) a scarcity of studies in several African countries with a high number of COVID-19 cases, b) high heterogeneity among the studies, c) the extent of prevalence of mental health symptoms in Africa to be high, and d) the pattern of mental health symptoms in Africa differs from elsewhere, i.e., more African adults suffer from depression rather than anxiety and insomnia during COVID 19 compared to adult population in other countries or regions. Hence, our findings carry crucial implications for healthcare organizations and future research to enable evidence-based medicine in Africa. Our findings also call for increased scholarly attention on Africa, the least studied continent with a limited amount of research on mental health symptoms under the COVID 19 pandemic. Trial registrationCRD42020224458

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ObjectiveThis paper systematically reviews and assesses the prevalence of anxiety, depression, and insomnia symptoms in the general population, frontline healthcare workers (HCWs), and adult students in Spain during the COVID-19 crisis. Data sourcesArticles in PubMed, Embase, Web of Science, PsycINFO, and medRxiv from March 2020 to February 6, 2021. ResultsThe pooled prevalence of anxiety symptoms in 23 studies comprising a total sample of 85,560 was 20% (95% CI: 15% - 25%, I2 = 99.9%), that of depression symptoms in 23 articles with a total sample comprising of 86,469 individuals was 23% (95% CI: 18% - 28%, I2 = 99.8%), and that of insomnia symptoms in 4 articles with a total sample of 915 were 52% (95% CI: 42-64%, I2 = 88.9%). The overall prevalence of mental illness symptoms in frontline HCWs, general population, and students in Spain are 42%, 19%, and 50%, respectively. DiscussionThe accumulative evidence from the meta-analysis reveals that adults in Spain suffered higher prevalence rates of mental illness symptoms during the COVID-19 crisis with a significantly higher rate relative to other countries such as China. Our synthesis reveals high heterogeneity, varying prevalence rates and a relative lack of studies in frontline and general HCWs in Spain, calling future research and interventions to pay attention to those gaps to help inform evidence-based mental health policymaking and practice in Spain during the continuing COVID-19 crisis. The high prevalence rates call for preventative and prioritization measures of the mental illness symptoms during the Covid-19 pandemic.

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Policymakers and researchers describe the COVID-19 epidemics by waves without a common vocabulary on what constitutes an epidemic wave, either in terms of a working definition or operationalization, causing inconsistencies and confusions. A working definition and operationalization can be helpful to characterize and communicate about epidemics. We propose a working definition of epidemic waves in the ongoing COVID-19 pandemic and an operationalization based on the public data of the effective reproduction number R. Our operationalization characterizes the numbers and durations of waves (upward and downward) in 178 countries and reveals patterns that can enable healthcare organizations and policymakers to make better description and assessment of the COVID crisis to make more informed resource planning, mobilization, and allocation temporally in the continued COVID-19 pandemic. One Sentence SummaryA working definition and operationalization of waves to enable common ground to understand and communicate COVID-19 crisis.

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Wearing a face mask has been recognised as an effective way of slowing down the spread of the Covid-19 pandemic. However, there is scarce evidence on predictors of face mask wearing during a pandemic. This research aims to investigate which demographic and hygienic factors could predict the compliance for face mask wearing in Malaysia. We employed a structured online survey of 708 Malaysian adult respondents. Among the factors examined, we found gender, hand washing and wearing of personal protective equipment significantly predicted face mask wearing.

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This paper provides a systematic review and meta-analysis on the prevalence rate of mental health issues of general population, general and frontline healthcare workers (HCWs) in China over one year of the COVID-19 crisis. We systematically searched PubMed, Embase, Web of Science, and Medrxiv at November 16th, 2020, pooled data using random-effects meta-analyses to estimate the prevalence rates, and ran meta-regression to tease out the heterogeneity. The meta-regression results uncovered several predictors of the prevalence rates, including severity, type of mental issues, population, sampling location, and study quality. Pooled prevalence rates are significantly different from, yet largely between, the findings of previous meta-analyses, suggesting the results of our larger study are consistent with yet more accurate than the findings of the smaller, previous meta-analyses. The prevalence rates of distress and insomnia and those of frontline HCWs are higher suggest future research and interventions should pay more attention to those mental outcomes and populations. Our findings suggest a need to examine the prevalence rates at varying levels of severity. The one-year cumulative evidence on sampling locations (Wuhan vs. non-Wuhan) corroborates the typhoon eye effect theory. Trial registrationCRD4202022059

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BackgroundThe recent outbreak of COVID-19 impacts the mental health of people worldwide. The mental conditions and the associated predictors of adults in Pakistan, the fifth most populous country in the world, during the COVID-19 remains understudied. We aim to investigate distress, anxiety and overall mental health and their associated predictors among Pakistani adults in this pandemic. We specifically examine the mental health issues based on the distance to the epicenter, a predictor that has revealed opposing evidence in other countries based on the theories of typhoon eye effect and ripple effect. The samples consist of 601 adults who were surveyed online about 2.5 months into the outbreak across Pakistan with varying distance to the epicenter of COVID-19 of Karachi in Pakistan. ResultsThe results showed that 9.2% and 19.0% of the participants surpassed the cut-off of distress and anxiety disorders, respectively. Overall, the distance to the epicenter positively predicted the mental health of adults in Pakistan, and family size negatively moderated this effect. The distance to the epicenter negatively predicted distress and anxiety disorders for adults in large families, which are quite common in Pakistan. ConclusionThe evidence of the study interestingly finds the prediction of the mental health of people by their distance to the epicenter depends on the family. The evidence of this study can help to provide the initial indicator for mental health care providers to screen vulnerable groups in Pakistan, a populous country that continues to struggle to cope with the COVID-19 pandemic.

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BackgroundHealthcare staff are the forefront of fight against COVID-19 and they are under enormous pressure due to the fast growth in the number and severity of infected cases. This creates their mental issues such as distress, depression and anxiety. Exploring healthcare staffs mental health during the pandemic contributes to improving their persistence in the growing challenges created by COVID-19 and enabling effective management of their mental health. MethodsAn online survey of 280 healthcare staff in all the 31 provinces of Iran was conducted during April 5-20, 2020. The survey assessed staffs distress, depression and anxiety in the COVID-19 pandemic. ResultsNearly a third of healthcare staff suffered from distress, depression and anxiety. Females and more educated healthcare staff were more likely to experience distress. Compared to personnel who did not have COVID-19, those who were unsure whether they had COVID-19 were more likely to experience distress and depression. The number of COVID-19 cases among the staffs colleagues or friends positively predicted their anxiety. Compared to radio technologists, doctors were less likely to experience distress and anxiety. Technicians and obstetrics experienced less anxiety. Analysis the interaction between weekly working days and age of the staff indicated the chance of experiencing distress and depression varied greatly by working days among younger but not older healthcare staff. ConclusionThe predictors of mental health issues assists healthcare organizations to identify healthcare staff with mental health issues in sever crises such as the COVID-19 pandemic. Our research highlight the need to identify more working characteristics as predictors for healthcare staff at different ages. FundingThis work was supported by Tsinghua University-INDITEX Sustainable Development Fund (No. TISD201904).

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BackgroundResearch identifying adults mental health during the COVID-19 pandemic relies solely on demographic predictors without examining adults health status during the COVID-19 pandemic as a potential predictor. MethodsAn online survey of 669 adults in Malaysia was conducted during May 2-8, 2020, six weeks after a Movement Control Order (MCO) was issued. FindingsAdults health condition had curvilinear relationships (horizontally reversed J-shaped) with insomnia, anxiety, depression and distress. Reported test availability for COVID-19 (from "strongly disagree" to "strongly agree") also had curvilinear relationships (horizontally reversed J-shaped) with anxiety and depression. Younger adults reported worse mental health, but people from various religions and ethnic groups did not differ significantly in reported mental health. InterpretationAdults with worse health conditions had more mental health problems, especially adults at the lower end of the health spectrum. Test availability negatively predicted anxiety and depression, especially for adults experiencing poor COVID-19 test availability. The significant predictions of health condition and COVID-19 test availability suggest a new direction for the literature to identify psychiatric risk factors directly from health related variables during a pandemic. FundingTsinghua University-INDITEX Sustainable Development Fund (Project No. TISD201904).

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The emerging body of research on the predictors of mental health in the COVID-19 pandemic has revealed contradictory findings, which prevent effective psychiatry screening for mental health assistance. This study aims to identify the predictors of nonsomatic pain, depression, anxiety, and distress, especially focusing on age as a nonlinear predictor. We conducted a survey of 474 adults in Iran during April 1-10, 2020, when Iran had just passed its first peak of the COVID-19 pandemic with new confirmed cases. We found that Age had a curvilinear relationship with nonsomatic pain, depression, and anxiety. Age was associated with pain, depression, and anxiety disorders negatively among adults younger than 45 years, but positively among seniors older than 70 years. Adults who were female, unsure about their chronic diseases, and exercised less per day were more likely to have mental health issues. This study advances the use of age as an effective predictor by uncovering a curvilinear relationship between individuals age and mental health issues by using a sample of adults across a wide spectrum of ages. We hope future research on mental health during COVID-19 pays more attention to nonlinear predictors.